Self Care 2025: Atopic Dermatitis, Dry Skin, Contact Dermatitis - MB

What are the functions of the Skin?

-Maintains the body form

-Helps excrete waste

-Protection from infection, dehydration, changes in temp

-Protects body from sun

-Generate Vitamin D

-Helps us feel touch, pressure, pain, heat/cold

What is Atopic Dermatitis

Common, pervasive inflammatory condition of the epidermis and dermis characterized by episodic flares and periods of remission

When is atopic dermatitis most likely to appear?

50% appear in first year of life, most have remission by age 2, 30% continue into adulthood

Why does atopic dermatitis occur?

-Deficient skin barrier properties, decreased ability to retain moisture, increased allergen penetration

What is the Atopic Triad?

Asthma, allergic rhinitis, and atopic dermatitis.

Treatment Goals for AD

-Stop the itch/scratch cycle

-Maintain skin hydration and barrier function

-Prevent secondary infection.

Treatment Goals for Dry Skin

-Improve skin hydration and minimize water loss

-Restore the skin's barrier function

-Educate the patient about prevention/treatment of this chronic disorder

AD Treatment Exclusions

-Moderate to severe condition with intense pruritis

-Involvement of large area of the body

-<1 y/o

-Skin appears infected (yellow crusty)

-Involvement of face or intertriginous areas (where two skin areas may touch or rub together)

What are non-pharm therapies for AD

-Avoid exacerbating factors/triggers

-Clip nails and cover hands with socks/gloves at night

-AD: for weeping lesions, apply cool compress for 5-20 min, 4-6x daily

Proper Bathing Techniques

-Consider bath oil with colloidal oatmeal

-Every other day and brief

-Tepid water

-Air/pat dry, no excessive rubbing

-Apply moisturizer 3 minutes after bathing

-Use fragrance-free products

-Avoid common bar soaps, use mild non-soap cleansers (like Cetaphil) instead

What can you give for itching for AD?

-Hydrocortisone 0.5% or 1% cream or ointment

-Useful when skin is itching or inflamed

-If skin is weeping avoid ointment formulation

-Avoid if skin is infected: refer!

-OTC strength steroids are safe for use on the face/groin area

Directions for Hydrocortisone Use

Apply a thin film to the affected area 1-2 times daily for no more than 7 days without physician's approval

What would you recommend for AD if a patient has oozing/weeping lesions?

Aluminum acetate to dry lesions

Characteristics of Dry Skin

-Roughness, scaling, loss of flexibility, fissures, inflammation, pruritus

-Decreased water content of skin with resultant abnormal loss of cells from stratum corneum

Some causes of dry skin

-Detergents, malnutrition, physical damage, systemic disorder such as hypothyroidism or dehydration

-Decreased amount of ceramides which leads to water loss

*Advancing age = thinner epidermis

Products for Dry Skin

-Emollients (Petrolatum: Vaseline, Aquaphor)

-Humectant (Urea 10% lotion)

-Alpha Hydroxy Acids (Ammonium Lactate Cream-Amlactin, Lac-Hydrin)

-Ceramide (CeraVe)

What is presentation of Irritant Contact Dermatitis

Typically appears on face, hands, and forearms after single or multiple exposures to an irritant

Treatment Goals for ICD

-Remove the offending agent and prevent future exposure to the irritant

-Prevent development of chronic dermatitis or secondary infection

-Relieve inflammation, dermal tenderness, and irritation

-Educate the patient on self-management to prevent or treat recurrences

Best treatment option for ICD

-Find out what is causing the irritation, and remove irritant

-Wash with tepid water and mild soap

-Avoidance: wear protective clothing or gloves

What pharm options can be used for ICD

-Use emollients or moisturizers

-Colloidal oatmeal baths to relieve itching

-Hydrocortisone may help with inflammation

What is allergic contact dermatitis?

Reaction Caused commonly by poison ivy/sumac/oak

-Urushiol (oo-roo-she-all): oily allergen that causes ACD

Characteristics of ACD

-Presents as a rash generally within 24-48 hours after exposure

-Causes itching, weeping, and may cause papules and vesicles

Treatment Goals for ACD

-Treat the inflammation

-Relieve itching and excessive scratching

Treatment Exclusions for ACD

-<2 y/o

-Dermatitis >2 weeks

-Involvement of >20% of BSA

-Presence of numerous bullae

-Extreme itching, irritation, or severe vesicle or bullae formation

-Swelling of the body or extremities

-Swollen eyes or eyelids swollen shut

-Discomfort in genitals from itching, redness, swelling or irritation

-Involvement and/or itching of mucous membranes of mouth, eyes, nose, or anus

-Signs of infection

-Failure of self-management after 7 days

-Low tolerance for pain, itching, or symptom discomfort

-Impairment of daily activities

Non-Pharm for ACD

-Know characteristics of plants and remove them

-Keep fingernails trimmed

-Apply Zanfel to the affected areas

Pharm therapy for ACD

-For inflammation: Apply hydrocortisone 1% cream 3-4 times daily up to 7 days

-For weeping, apply Burrow's solution compress 20-30 min, 4-6 x day (astringents)

-For itching: 1st gen oral antihistamines to help sleep

What treatment therapies should you avoid with ACD?

-Topical Anesthetics

-Topical Antihistamines

-Topical Antibiotics (neomycin)

How does Zanfel work?

-Removes urushiol by binding with it to create an aggregated cluster, wash away with water

-Safe for use by children and pregnant or nursing women

When and where can Zanfel be used?

-Can be used at any time after exposure

-Can be applied on any external body area, including the face and genitals

How does Tecnu Medicated Poison Ivy Scrub work?

Wet affected area and apply desired amount of product on affected area. Rub gently for 15 seconds, rinse with cool water, and towel dry gently

When can you use Tecnu Medicated Poison Ivy Scrub?

Use within 8 hrs post-exposure to remove urushiol before rash begins

How do you use the Tecnu Outdoor Skin Cleanser?

Apply to dry skin and rub vigorously for 2 min. Rinse with cool water or wipe off with a cloth

-Use also to remove any oil from objects and pet fur

When can you use the Tecnu Outdoor Skin Cleanser?

-Use within 8 hrs post-exposure to remove urushiol before rash begins